MEDICARE: MERIDELL ACHIEVEMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility	050218	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	786420000	OTHER	TX	CHAMPUS

General Provider Information

NPI Number	:	1801863311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDELL ACHIEVEMENT CENTER

Provider Business Mailing Address
First Line	:	12550 W HWY 29
Second Line	:
City	:	LIBERTY HILL
State	:	TX
Zip	:	78642
Country	:	US
Telephone Number	:	512-528-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	12550 W HWY 29
Second Line	:
City	:	LIBERTY HILL
State	:	TX
Zip	:	78642
Country	:	US
Telephone Number	:	512-528-2100
Fax Number	:

Authorized Official
Title or Position	:	CFO/ SR VP
Name	:	STEVE FILTON
Credential	:
Telephone Number	:	310-768-3300

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	01/05/2015

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Directions to “MERIDELL ACHIEVEMENT CENTER ” Practice Location

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